Alex B. TMS and tendonitis

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Question

Hello,

My name is Felipe Aranha, i'm a 31 years old guitarist from Brazil.
I've been suffering (supposedly) from "Tennis Elbow" for 3 years and it's driving me insane because it interferes directly with my professional activity (playing guitar).
I've made a lot of exams and scans that show that my my elbow tendons are a bit sore, but "nothing serious".
I've tried A LOT of treatments too and nothing seems to help much.

After reading Dr.Sarno's books i've experienced a SIGNIFICANT relief.
Something like 90/95% less pain.

But now, some 2 months later, i'm beginning to experience a little bit of increasing pain when practically ONLY when i start to practice my instrument.

My question is:
TENDONITIS (which "Tennis Elbow" seems to be) is ALWAYS a case of TMS?

I mean, i'm relatively young and healthy and i'm not doing something abusive with my body for all i know (although i confess i practice A LOT) why this condition lingers on and so intermittently?

I have to admit that i have all the traces of personality that Dr.Sarno describes as prone to have TMS (perfectionist, goodist...)

How can i know i am not physically hurting myself more and more when start practice/play?
How can i be sure that i only have TMS and have to focus only in my subconscious rage?

Thanks a lot!

 

Answer

Hi Felipe, thanks for posting.

Let me start by saying that tendonitis is not in fact always a case of TMS, but that it is a very common manifestation of it. However, this doesn't really matter because in your case, it is seems to clearly be TMS! From what I can see, by far the most important element of what you report is that after becoming aware of TMS you experienced a very significant relief of symptoms. This kind of evidence is like the holy grail of dealing with TMS, because it can allow you to confront and challenge the fears and anxieties that the symptoms create, knowing that in fact they are not coming from physical, structural damage to your body.

The specific nature of your symptoms offers further evidence. Very often TMS will directly affect things that we use to make ourselves happy or that are very important to us. A singer will develop acid reflux, a writer will experience carpal tunnel and, in your case, a musician will experience pain in their hands. I see this so very often, and my clients will usually say things like "If only I could do 'X' then I would feel so much better". This is exactly why the pain affects you in these places, because it is where you are vulnerable. It demands your attention and keeps your preoccupied, which is the purpose behind the pain. If it affected your little toe, you wouldn't notice or care and it wouldn't be able to scare you like it does. It is this fear and anxiety generated by your symptoms that you want to try to address.

You have a lot going for you: Strong concrete test results showing minimal structural issues, strong symptom response to awareness of the mind-body connection, and very identifiable conditioned responses. By using this evidence to help comfort and support yourself as you engage with the pain, you will hopefully be able to begin to develop the confidence to address what is happening underneath the anxiety and pressure.

I hope this is somewhat helpful. Thanks for the good question.

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Any advice or information provided here does not and is not intended to be and should not be taken to constitute specific professional or psychological advice given to any group or individual. This general advice is provided with the guidance that any person who believes that they may be suffering from any medical, psychological, or mindbody condition should seek professional advice from a qualified, registered/licensed physician and/or psychotherapist who has the opportunity to meet with the patient, take a history, possibly examine the patient, review medical and/or mental health records, and provide specific advice and/or treatment based on their experience diagnosing and treating that condition or range of conditions. No general advice provided here should be taken to replace or in any way contradict advice provided by a qualified, registered/licensed physician and/or psychotherapist who has the opportunity to meet with the patient, take a history, possibly examine the patient, review medical and/or mental health records, and provide specific advice and/or treatment based on their experience diagnosing and treating that condition or range of conditions.

The general advice and information provided in this format is for informational purposes only and cannot serve as a way to screen for, identify, or diagnose depression, anxiety, or other psychological conditions. If you feel you may be suffering from any of these conditions please contact a licensed mental health practitioner for an in-person consultation.

Questions may be edited for brevity and/or readability.

 

Hi, Felipe. First of all, I LOVE classical and flamenco guitar. I don't play, but listen to it a lot.
My favorite guitarists are the ones we all know, but I began loving the instrument from the recordings
of Christopher Parkening.

I am sorry you have some pain from "tennis elbow" while playing the guitar, but agree with Alex Bloom.
You have to be careful not to develop a conditioned reflex that starting to play the guitar will bring on pain.
It will not be from any structural problem because tests for that have proved negative.
It is from worrying, and you say you know you are a perfectionist and goodist person.

Those are often hard to live with, but they can be controlled. I am both myself, but have learned
that for my own good health, I modify both. I try not to push myself to work too hard or to be so perfect
in my work as a writer. And I am more cautious in being too kind and generous to others. I've found that
often my friends take advantage of it. Some will eat me alive if I let them in their search and desire for
attention.

Go easier on yourself and enjoy playing the guitar as I enjoy writing. It takes me out of myself.

 

I am an amateur classical guitarist but have suffered very similar symptoms.
Following seven years of not playing because of pain I read the Mind and body book. I was very excited by it and although I didn't really believe what I was reading I decided to give it a try,about six months ago, because of all the testimonials I read. Within two days my pain was massively reduced and I began playing again. I have been making excel lent progress until about three weeks ago when symptoms returned in my fingers and forearms and then this week in my neck back and shoulders.I don't know what to do now because I'm frightened of returning to the really awful pain I had before.
When I had physiotherapy I was told that the tendons were very sticky and did not slide across each other like v they should. Does this mean it really is tendinitis or could it actually be TMS?
Help!
BTW I can acknowledge that I am very skilled at certain things in life but believe I am pretty useless at many physical activities !

 

Alex, you've said here that TMS is not always the cause for tendinitis. Can you elaborate?
This is a serious cause to doubt that my tendinitis symptoms are not structural.

 

Hi Felipe and @Ithurts,

This is a post I did in August. Thought it might help you. I have little flare ups here and there but returned to work doing massage therapy 2 weeks ago. 4.5 hours of massage the first week, only the first massage hurt my arm, but the rest of the week, the tools I've learned from this wiki, meditation, and journaling really have helped immensely. Last week a little flare up, but no problem, it didn't stop me from massage--

After a 6 month battle with “tendinosis” I am now 95% with all activities no pain, and winning the battle. I couldn’t be happier. It took a while to accept TMS, but am so happy that I had to make a choice—to put faith and courage in myself and intuition, and let go of what the doctors have said.

7+ months ago, while I was working on a massage client, I felt a sharp pain in my right forearm. The anxiety and fear around the pain increased, as half of my income was from working as a massage therapist. I tried working through the pain, but it only intensified. I sought out two doctors and an MRI, which revealed nothing. A third doctor diagnosed me with Tendonitis/tendinosis of my thumb and forearm extensors.

I was devastated, depressed and anxious. A few months prior to the injury, I had just graduated from a 5 year master degree program and was just starting my practice and business. From this injury, I lost all of my massage clients, and half of my income. The anxiety and Depression, as well as the shame that I couldn’t heal myself was hard.

I did PT but many times just felt worse afterwards. The only thing that helped was wearing a wrist brace, and I wore that pretty consistently for 6 months. I also tried acupuncture, massage, herbs, ultrasound, tens/estim, cortisone, and finally found Dr. Sarno. His theories made sense to me. 10 years prior to this, in my mid 20’s, I had constant medically unexplained throat pain for 2 years, then followed by unexplained Shoulder, wrist and ankle pain for 8 months. Finally my doctor at the time sent me to a Mind Body Stress Reduction course. Thank god. It was my first exposure to mindfulness and meditation. Eventually the throat and joint pain cleared. Needless to say, Sarno’s theories made sense to me with this bout of forearm pain, and I wanted to believe badly, that this “injury” was psychological in nature because recovering from tendinosis would be incredibly difficult according to research, and the doctor and physical therapist told me I would never be able to go back to doing massage therapy.

In my mind, I switched back in forth between this being a physical injury and a mind-body, or psychosomatic condition. Once I would convince myself it was psychosomatic, I would go a few days totally pain free. Then I would push myself too much, do a lot of forearm and thumb extension and “reinjure” myself. The pain would flare up again and I would return to the battle in my mind, and the wrist brace.

A month ago, the night of my birthday, I woke up at 3 am with bad shoulder pain on the left side of my body. I couldn’t lift my Arm or bend my Elbow without a lot of pain 7/10. The doctor quickly diagnosed me with biceps tendonitis. Even I was convinced it was, as the pain had showed up a few weeks prior while swimming (though when it first appeared I was convinced it was TMS because I had read about the moving of pain in Sarno’s books, and would tell the pain to go away and it would.)

Finally after battling with this pain in my left shoulder for 3 weeks, and at some point reinjuring my right forearm again and not having any use of my arms for about a week, I realized something. The night my shoulder pain really started and persisted, my preteen stepdaughter chose not to wish me happy birthday. I tried to tell myself that it was ok, and just let it go, but inside I was deeply hurt and disappointed. I made this realization at night, and by the next morning, the shoulder pain was completely gone. 100%.

After this, I am now mostly convinced my forearm pain, RSI and tendinosis is TMS. It’s been hard to 100% accept because there is no TMS doctor in Hawaii. I started seeing a psychologist about 2 months ago at a chronic pain clinic, because of the inkling this was a psychological issue, but he continued to focus on my “physical” injuries and helping me cope with that. My intuition told me otherwise, and as I gain the courage within myself to not rely on the doctors, physical therapists and psychologist for a TMS diagnosis, I find myself growing stronger everyday with more and more pain reduction. Right now I’m at about 95%. (But believe me, a week ago, taking off that wrist brace for the very last time caused quite the pain flare!).

I’m not pushing myself to be 100%. It seems counterintuitive. I would love to get back to massage but am accepting myself where I’m at and in this process. I am actually thankful this happened, because as an acupuncturist and massage therapist, I now have a deeper understanding of the mind, the spirit and the body. I would agree with Sarno that what is commonly diagnosed as physical injuries in the body are just manifestations of psychological pain and suffering. I see it so much in my own patients I treat with acupuncture and am saddened I cannot approach this subject with many of them. So now I just need the tools to be able to do so… I think I will be going back to school to get my master’s in mental health counseling

I will check back in soon and let you all know how I’m doing. Take care and be strong everyone!!

Aloha, Andrea

 

I don't know what would be Alex's answer. My answer is: tendinitis can very often have physical causes. If we pull a muscle, injured a tendon or some other parts of our body and the result is tendinitis pain. The different between physical and emotional cause is the physical one will always heal in days or weeks time, always. Any pain last longer than a couple months are usually have tms/anxiety causes. Our body have an amazing ability to heal itself with minimal help from us. Broken bone can heal in 6 to 8 weeks. My hernia surgery healed in 5 weeks.

 

Hi I would like to know when it is safe to say it isn't tendonitis? I was diagnosed with a mild tendonitis due to inflammation on both sides of my elbow on both arms. There is no visible tear of the tendon and my physiotherapist says I have a mild tendonitis. I'm really scared to cause serious injury. I stopped playing guitar for a month and am starting again. I have more pain since I began but I understand that could just be conditioning. I'm not sure where or who to turn to for the answer to this question. I realize that I am asking the same question as the initial one that started the thread but with the addition of "inflammation." I just want to know if it's physical or not so I can move on with continuing physical activity...

 

I know exactly that frustration you are going through with your hands, but I can assure you, it is definitely TMS. I smashed my hand really hard a year ago and I was in a bit of pain afterwards. But over the next couple days, I noticed my pain was decreasing, so I was feeling better. However, a week later after the injury, I woke up and all of a sudden I couldn't move my hand. And at this point, I was freaked out. So here begins the flurry of tests with doctors and physical therapists. I went to five different surgeons, and the only thing they could find was a small ganglion cyst in my wrist, which is hardly anything to worry about and would never cause this much pain. Even the doctor said that, however, the doctors would never admit it was psychosomatic. So I was like this for about a year, bouncing from doctor to doctor, in hopes of getting an answer, but I finally hit the point where I just realized there isn't anything wrong. So I ripped off all my hand and wrist braces and just said I'm going to approach this the TMS way and stop living in fear. Literally an hour after I did that, I developed the worst carpal tunnel pain. My fingers and wrists started burning and that caused a flood of fear to enter my mind, and then all of a sudden the pain bounced over to my left hand and wrist! So I talked to a neurologist to get that nerve conductance test done, and he said it was all normal. But this neurologist actually took the time to listen to my story and frustration, and he assured me that this "carpal tunnel" pain was purely psychosomatic. So after a meeting with a TMS therapist as well as a TMS doctor, who were adamant that this hand pain was TMS, I began the road to recovery. I felt my hand grow stronger daily and all that pain started to subside. I'm still recovering, but I know with full confidence that this is TMS and it's your mind playing on your vulnerabilities. I'm studying to be a compound pharmacist, which involves the use of my hands to make the medications, so I had a constant fear that my career was ruined due to my diagnosis of having "Carpal tunnel and tendonitis." And it was that fear that kept the pain alive for me. So just approach your pain as if you didn't have any. All your tests came back normal, so there is only one answer for what is causing this, and you already know what it is. But like you indicated above, it does take patience as results are not always immediate.

 

Shooting legs pain after tripping on something plz help

Hi everyone. I have been suffering from back and legs pain from almost 3 years. The pain in the legs is really different and I can feel the pain starting from my lower back and going down to my heals with burning sensation also. I started to feel better after going through the tms recovery program. listened to 20/20 and read healing back pain. I was 100 hundred % sure about the tms and serious about dealing with it. Last week the pain was reduced to 6/10 instead of 9/10. I went out for a walk last eve and on my way back i tripped on the side walk and all the sudden there was a shooting low back back and legs pain down to heal with burning sensation. Literally put me on the ground in a moment and my whole night was a nightmare. This is not the first time it has happened it always happens right after I trip onto something or accidentally hit my one of the feet into something and I always try to ignore it but no this thing would not go away. It makes me scream any time it happenes and it takes at least a week to get back to normal (still abnormal since the pain 6/10 is always there).I dont know whats going on. I gather some courage every time to apply dr. Sarno's theory. I ignore it when I have pain while sitting, working, bending or doing anything and talk to my brain and the pain seems to fade a little bit. But, again when that small incident of tripping happens again the nightmare comes back to make me cry for the whole week. Any help

 

Hi Jay, what helped me overcome my neurological pain in my hands was when I had a nerve conductance test. When it all came back clear and the neurologist couldn't find anything wrong, it put my mind at east and that pain vanished. So maybe getting that test will put your mind at ease. But to be honest, tripping over that sidewalk should not be causing that type of pain, I just don't see the body being that weak. When my hand pain was at it's worst, any time I accidentally bumped it, it would send me into a downward spiral and the pain would become very intense. That exaggerated response was a dead give away that my brain was up to no good.

 

Great observation, I love this quote. It's true, "exaggerated" response does say something is up.

 

I'm glad I happened upon this thread. Alex Bloom, MSW, you said..."Very often TMS will directly affect things that we use to make ourselves happy or that are very important to us. A singer will develop acid Reflux, a writer will experience Carpal Tunnel and, in your case, a musician will experience pain in their hands. I see this so very often, and my clients will usually say things like "If only I could do 'X' then I would feel so much better". This is exactly why the pain affects you in these places, because it is where you are vulnerable. It demands your attention and keeps your preoccupied, which is the purpose behind the pain. If it affected your little toe, you wouldn't notice or care and it wouldn't be able to scare you like it does. It is this fear and anxiety generated by your symptoms that you want to try to address."

My mind is BLOWN. I am a photographer, have been for over 25 years. In 2013, after a severely stressful family trip, I had what can only be called a "nervous breakdown". I began a down spiral of symptoms (mental & physical) that began with migraines and panic attacks and moved into TMJ and neck pain, and eventually "settled" in my right arm, right shoulder, neck and upper back muscles. The EXACT places that I use as a photographer. Could you please explain what you mean by 'Very often TMS will directly affect things that we use to make ourselves happy or that are very important to us.' I find this FASCINATING. BTW, I was cleared by Dr. David Schechter, full blown TMS, have had TMS my whole life (tummy aches as a kid, frequent colds, sore throats and allergies in my teens (I was a voice over actor at this point!), IBS in my 20's, anxiety and depression in my 30's, but never did it affect my shoulder and neck UNTIL I decided to make photography my full time career. Why does this happen and how can I best get through it so I can fully get back to work? I am working as a photographer, but whenever I really hunker down and begin to gain some traction and success, my TMS flares big time. I would love any thoughts from the group on this...I really want to de-condition myself. I know my camera and sitting at my computer isn't CAUSING my pain, but man, my shoulders feel like I am carrying a thousand pounds on them when I pick up my camera, and when I sit at my computer just for fun, I get very little pain, but when I start into PhotoShop for work...BAM, my shoulder feels like a frozen block of ice.

 

Dhv,
To answer your question, the term tendonitis is often mistakenly used to describe tendinosis. Tendonitis is an inflammation of the tendons that can be observed by diagnostic tools (MRI, unltrasound, I believe.) Like Alex said, this very much can be a real condition that can be treated from a musculoskeletal perspective.

Tendinosis on the other hand (and what most people mean when they say tendonitis) is pain without inflammation. Often physicians will diagnosis someone with this condition is there is pain without any physical findings.

Alan

 

Like most people I read on this sight I waver between a Celtic g the tms theory and doubt. All I know is that I have suffered for a long time with hand and forearm symptoms and in the last two years from reflux as well.Im an amateur singer and guitarist and the tms idea seems to fit and like you I never had any symptoms like this before I started to really e enjoy the two activities. The reason I'm writing today is because you say you don't get symptoms if you're using g the computer for non work you don't get any. I have recently told my teacher the same thing. If I'm playing music I experience the odd two he but if I start to do exercises on the guitar the pain jumps back (I almost wrote"with a vengeance's, as if the pain's got a mind of its own !) This really does seem like very powerful evidence to me.W with the reflux I was given all the standard medications to no effect .I had uv scan and barium meal both negative and the consultant said everything is fine and amazingly my symptoms are down 95 per cent .

 

Sorry my phone is misbehaving.I meant to write accepting not Celtic!

 

I have adductor tendinitis and sartorial muscle tendinitis documented via two ultrasounds. Injuries from distance running. I have had it for two years. It comes and goes. Very painful and even hurts walking when it flares. Even though there was an actual injury, could the fact that I never really fully healed and the on and off chronicity of it be TMS? I have other symptoms of possible TMS as well. Any responses would be appreciated!

 

Yes it could be TMS. My personal opinion(!) is that it may have healed, but your brain has difficulty letting go (pain) and still causes physical reactions (swelling) as if it hasn't healed. I have no idea what you can see on a ultrasound, but if they don't see a tear, I don't think there is anything wrong with your tendons. The fact that you have multiple symptoms without a good explanation, makes it even more probable that all your symptoms are indeed TMS. I also find it fascinating that you have two tendons with the same problem, what are the odds?
We are not doctors, so you either have to get the all clear from a medical (preferably TMS) doctor or you decide to take the TMS plunge at your own risk. Also, do a search on this forum for the things you suffer from and read the stories of other people with similar problems.
take care!

 

Thanks for your reply. Good way to put it-- it might be healed but my brain can't let go. Makes sense. I actually did see a TMS doctor and was told that it is clearly TMS. Also have neck pain of two years from aggressive biking, GERD, and history of migraines. The injuries were extremely psychologically traumatic for me because I loved running so much and felt I had to stop. Then biked and had another injury. The thing is, I get it intellectually that this could all be TMS but I am having trouble getting past the fear that this is structural. I did have MRI of my neck which showed arthritis, herniated disc, spodylolithesis, stenosis. So my imaging is not clean. Makes it harder to believe my mind is perpetuating the symptoms but it does make sense. My anxiety about medical issues is crazy high which feeds into it by creating fear. I am having trouble getting past the fear.

 

WHY DON'T YOU TRUST HIM? If I got your dx, I would be tickled pink and would be running off into the sunset. Can you tell us who the TMS doctor was, maybe I'd like to see him myself.

Your narrative is all in the structural vocabulary--what is going on emotionally? Have you checked the HOLMES-RAHE list for the emotional triggers?

Have you read any of Dr. Sarno's books? In them he says there is no such thing as a perfect spine. All the thing you mentioned can be TMS "gray hair of the spine" anomalies.